Lecture 26 Management of Type 2 Diabetes Part 2 Flashcards
1
Q
Name a DPPIV Inhibitor
A
Gliptins
• Sitagliptin
• Saxagliptin
• Vidaglip
2
Q
What is the function of Gliptins
A
are DPP-4(enzyme) inhibitors that delay the breakdown of incretins and thereby increase active incretin levels
3
Q
What are the advantages of Gliptins
A
- Usually well tolerated
- Can be used as 2nd or 3rd line agent
- Can be used in renal impairment
- No risk of hypoglycaemia
- Weight neutral
4
Q
What are the disadvantages of Gliptins
A
- Trial data shows relatively small effects on glycemic control
- CI in pregnancy and breastfeeding.
- Possible increased risk of pancreatitis and pancreatic cancer
- SE:nausea
5
Q
What are GLP-1 analogues
A
• Increase release of incretins
6
Q
What are the advantages of GLP-1 analogues
A
- Weight loss
- No risk of hypoglycaemia
- 3rd line agent
- Can be used with basal insulin
7
Q
What are the disadvantages of GLP-1 analogues
A
- Injection
- Very expensive
- Possible increased risk of pancreatitis and pancreatic cancer
- CI in pregnancy and breastfeeding.
- SE:Nausea, vomiting
8
Q
Whats the mechanism of SGLT2 inhibitors
A
- Increases excretion of glucose
* Reduces the amount of glucose reabsorbed by kidney in proximal tube
9
Q
What are the effects of Gliflozins
A
- Leads to increased urinary glucose excretion
- Glycosuria
- Lowers HbA1C
- Gets ride of water/osmotic diuresis
- Postural hypotension
- Dehydration
- Get rid of calories/waste glucose
- Lose weight with same intake
- Get rid of sodium/less reuptake
- Lowers systolic blood pressure
- Greater risk of urogenital pressure
- Cystitis and Candidiasis
10
Q
Advantages of SGLT2 inhibitors
A
- Weight loss
- No risk of hypoglycaemia
- Good effects on glycemic control
- May have beneficial effect on cardiovascular morbidity & mortality
- 2nd or 3rd line agent
- Can add to insulin regimens in T2DM
11
Q
Disadvantages of SGLT2 inhibitors
A
- Expensive
- SE:UTI, fungal infections, osmotic symptoms
- Risk of digital amputation
- Risk of DKA
- CI in pregnancy and breastfeeding.
- Cannot use in renal impairment